22 ms·

Mysterious heart damage, not just lung troubles, befalling Covid-19 patients

255 points by branko_d 7y ago

guscost 7y ago
One factor to consider: Some folks will be absolutely terrified to learn they have this disease, which may have real effects. An example: https://en.m.wikipedia.org/wiki/Voodoo_death https://en.m.wikipedia.org/wiki/Voodoo_death “These data suggest that vagus contributes to severe emotional states and may be related to emotional states of immobilization, such as extreme terror. Unfortunately, this immobilization technique is potentially life-threatening for mammals (but not for reptiles). Mammals would undergo states of bradycardia or hypoxia as an over-activation of parasympathetic vagus system. The organs of the oxygen-hungry mammal are deprived of oxygen due to lack of blood flow, and the animal dies.”
- graeme 7y ago
  That implies a low heart rate causing death, correct? If so, this would be an easy hypothesis to test based on heart rate. But also, do the rats in voodoo death have heart damage? These covid patients do. If the rats don’t, then you’re quite off track.
  - guscost 7y ago
    It's just one example of a heart-related effect, that's all. Considering that we're all here reading another hypothesis that this is the first-ever respiratory pathogen to infect the heart, it doesn't seem that much of a stretch. We totally should research whether fear can lead to physical heart damage, but I would bet that "stress in general" is the source of this damage, not only emotional stress. See: https://www.medicalnewstoday.com/articles/295664 https://www.medicalnewstoday.com/articles/295664 https://www.medicalnewstoday.com/articles/317478 https://www.medicalnewstoday.com/articles/317478
- Zenst 7y ago
  Not heard it called this, was aware of https://en.wikipedia.org/wiki/Broken_heart#Broken_heart_syndrome https://en.wikipedia.org/wiki/Broken_heart#Broken_heart_synd... I do recall reading few articles that support it as an actual condition and makes logical sense that for some that will be a factor - lost loved one in same family, increases the odds of catching the virus and also a broken heart. Truly a tradgerday on many levels. Also mindful that the impact of this pandemic will see many indirect deaths in the years to come and the scale of things won't be measured in people who died and tested positive, but how the rest live.
carlsborg 7y ago
There is a paper circulating that claims that the virus impedes red blood cells leading to organ failure including lungs, and not the other way round.
- bryanrasmussen 7y ago
  so if it impedes red blood cells does this mean my gout is helping me out?
  - tejtm 7y ago
    Could you explain the gout - bloodcell - lung damage connection to a non clinician? (me)
    - bryanrasmussen 7y ago
      well actually it's only some sorts of gout, caused by Polycythemia Vera https://rarediseases.org/rare-diseases/polycythemia-vera/ https://rarediseases.org/rare-diseases/polycythemia-vera/ "Gout and kidney stone associated with polycythemia vera occur due to the high turnover of red blood cells, which results in higher-than-normal uric acid production." So it overproduces red blood cells, and the parent comment said there was a theory covid-19 was causing a decrease in red blood cell production so I conjured the amusing scenario in my head of the two diseases fighting each other. An amusing, non-serious, scenario.
      - tejtm 7y ago
        I ask because I was recently doing background checks on a substance to mitigate nitric oxide induced lung damage (produced by damaged cells) which would work by by converting it to urea ... so maybe more than just amusing. and for you https://monarchinitiative.org/disease/MONDO:0005571 https://monarchinitiative.org/disease/MONDO:0005571
- nanl2053 7y ago
  Do you have a link?
bryanrasmussen 7y ago
is this 1 in 5 in people who are otherwise asymptomatic as well? I guess not, or we would be seeing a lot more dead but I wonder if there are any heart attacks occurring in otherwise asymptomatic people and not being marked down as Covid-19 related.
- ludamad 7y ago
  I just had a family friend die of a heart attack with no covid symptoms - definitely a scary time
  - deleted 7y ago
    [deleted]
  - juliushuijnk 7y ago
    A (distant) friend shared he lost his wife to hearth attack a couple of weeks ago out of the blue. I figure(d) it was random.
  - rootusrootus 7y ago
    My otherwise fit brother dropped dead of a heart attack without a single warning symptom of any kind. But that was a year ago, so not COVID.
- fock 7y ago
  we are seeing a lot more dead in heavily affected regions. and there is no statistics about why they died... Personally I think this is quite worrying with a lot of people now thinking we put masks on and then can go back to work. If this is indeed having serious side effects, we need to eradicate this. Meaning total lockdown except absolute necessities (e.g. ask: will people die of physical reasons if this service is out for a week) worldwide, implemented yesterday.
  - Bombthecat 7y ago
    Won't happen. We can't go in lockdown for 2 or three years..
PaulHoule 7y ago
There are ACE-2 receptors all over the heart.
- panax 7y ago
  https://www.youtube.com/watch?v=jAW6VBWTiAA#t=36m https://www.youtube.com/watch?v=jAW6VBWTiAA#t=36m ACE2 is also found in several other organs in which they are seeing multiple organ failure with this virus so it likely is can bind to them and contribute to damage in these organs including the heart but as OP says there are multiple ways the heart could be affected Loss of ACE2 receptors in the heart can cause impaired heart function https://www.youtube.com/watch?v=jAW6VBWTiAA#t=8m https://www.youtube.com/watch?v=jAW6VBWTiAA#t=8m
  - PaulHoule 7y ago
    Also there is a close connection between the heart, kidney, kidneys and other organs. For instance, ACE1 and ACE2 receptors are involved in a complex hormonal system that manages your blood volume, blood pressure, etc. Antihypertensive drugs target this system at different points. (ACE inhibitor drugs such as Lisinopril target the ACE1 receptor and don't bind much to ACE2 at all) Liver failure can present with symptoms similar to asthma because if your kidneys can't get rid of water, the water will leak out of your lungs. I had a friend who passed away last year from a bacterial infection that got to his heart. We all have bacteria that live on our skin without problems, but if you get a wound they can get into your blood and go to your heart. He had heart valve damage which is bad because if your heart valves work improperly, it can damage your blood the way you can 'damage' cream by whipping it. This can cause clots to go into your lungs or your brain with bad results either way. He had open heart surgery but they had a hard time restarting his heart and he was in a coma for a few months before they removed his feeding tube. One reason why penicillin was a miracle was that all sorts of people who got even minor wounds (e.g. soldiers, children, farmers, ...) would progress like that before WWII.
sharph 7y ago
Was reverse causation considered? Those with some heart damage are more likely to be tested and hospitalized for COVID-19?
- jpxw 7y ago
  Article addresses this
rightbyte 7y ago
I wonder if the patients get too much hydroxychloroquine. It can couse heart failures.
jpxw 7y ago
Disclaimer: I’m not a medical professional. My understanding is that myocarditis is a possible, albeit rare, complication of many viral illnesses? Additionally, respiratory failure causes a massive strain on the heart, so it’s not hugely surprising that many patients would have heart complications. It would be interesting to know how many patients without respiratory distress develop these cardiac symptoms.
- DanBC 7y ago
  This doctor in Wales says that myocarditis is a leading cause of death for his covid patients in ITU, and that this often happens after they've started to recover from the respiratory stuff. https://youtu.be/ejlbCmRJMW4?t=472 https://youtu.be/ejlbCmRJMW4?t=472
dcolkitt 7y ago
This headline is definitely a lot scarier than the actual body of the study. The most likely cause of the heart damage by far is the systemic inflammation induced by pneumonia. We know this because pneumonia patients of all types often have heart strain afterwards[1]. But that damage is very rarely permanent as the risk subsides back to baseline given enough time. Until we see evidence of heart issues in patients without pneumonia complications, we shouldn't be any more scared of covid-19 as we were before. In particular young and healthy people still have very little risk from infection. Patients who recover without serious complications should not be afraid of hidden heart damage. [1] https://www.health.harvard.edu/heart-health/heart-attack-risk-rises-after-a-bout-of-pneumonia https://www.health.harvard.edu/heart-health/heart-attack-ris...
- ck2 7y ago
  myocarditis can happen from any virus infection it doesn't have to involve pneumonia lots of young athletes die from it after coming back too hard/fast from flu
- deleted 7y ago
  [deleted]
- JumpCrisscross 7y ago
  > The most likely cause of the heart damage by far is the systemic inflammation induced by pneumonia Isn’t this premature given the lack of data? We’re seeing an anomaly documented and being studied. It’s not cause for alarm. But neither does it merit such dismissal.
  - SpicyLemonZest 7y ago
    I don't think it's premature, no. We have a lot of data indicating that it's a respiratory disease. It should be studied, almost any coronavirus anomaly is worth studying, but we know what conclusion to expect.
    - dboreham 7y ago
      Based on all the YouTube videos by doctors I've watched, heart failure is a known, expected and quite common consequence of severe respiratory disease.
411111111111111 7y ago
let me preface this by mentioning that i havent been tested for covid-19. two weeks ago i've been having real issues breathing. it felt like my upper body was borderline paralyzed and i had to really force myself to fully breathe in. this wasn't constant but happened every day for several hours each. especially at night. i got worried that i might have the virus so i checked my temperature and oxygen blood saturation as well as my pulse. temperature was fine (36.6°C-37.2°C), blood saturation was in the normal range, however it dropped from 97-100 when i wasnt having any issues to 94-97. my pulse rate however went from usually ~75-80 to >110 whenever i had breathing problems. it went away last week.. or so i though. i had another episode of that this morning, it was only for 3 hours today, however. it seems to be going away, but if it actually was (or is) the virus... it seems plausible to me. but i'm a person without any medical knowledge so ... listen to the people actually treating the patients, not random armchair specialists like they're frequent on hacker news -- especially in threads about covid-19.
- covidchat25 7y ago
  I've had the exact same symptoms as you: * Chest pain and breathing difficulties that gets worse at night. * Actually ended up on hospital twice because of it. * Pulse and blood pressure went high too.
  - TheOtherHobbes 7y ago
    Similar symptoms a few weeks ago. I've had an off-on mild fever since. There's been something going around since Jan at least, although it's impossible to know if it's Covid-related or something else.
- Cthulhu_ 7y ago
  You could be having panic attacks; based on the fact you've got numbers, it sounds to me like you're actively monitoring your own blood saturation, which already implies you may be worrying too much about things like that. Don't underestimate the effects of worry and stress. If it's temporary and you don't have other symptoms then you probably don't have the virus.
cowpig 7y ago
There's so much blind speculation in this comment section. The kind that's intriguing and fun when it's about engineering/math/whatever, but dangerous when it's about the health effects of an ongoing pandemic. I hope moderators do something about it.
- jpxw 7y ago
  Can you explain how exactly it is “dangerous”?
  - freehunter 7y ago
    Speculation on treatments for Covid-19 has already killed people: https://ktla.com/news/arizona-man-dies-after-taking-form-of-chloroquine-used-for-aquariums-in-apparent-attempt-to-treat-coronavirus/amp/ https://ktla.com/news/arizona-man-dies-after-taking-form-of-...
    - Cthulhu_ 7y ago
      Speculation is fine; this guy died from self-medicating. There is a difference. We shouldn't resort to censoring to protect stupid people.
      - deleted 7y ago
        [deleted]
    - trentnix 7y ago
      Guess what? ALL discussion about treatments for Covid-19 is speculation. That a Darwin award winner and his insane, political activist wife, neither of whom had Covid-19, ingested toxic chemicals (probably after indulging in mind altering chemicals) is not very good evidence that discussion on Hacker News should be curtailed in any way.
    - PaulHoule 7y ago
      Don't mess with pet meds no matter how tempting it may be. We have horses so we have phenylbutazone which is tempting to use instead of aspirin, ivermectin which you might be tempted to use instead of otc parental for roundworms, also a huge jar of thyroid hormone that might help you lose weight. I stay away.
nestlequ1k 7y ago
It's not "mysterious". Myocarditis is a common result of viral infections of any kind, and can persist for weeks after recovering from the virus itself.
throwawaylalala 7y ago
Scroll down to figure 1. Non survivors end up with cardiac and kidney injury. Interesting that this might shine light on the cause. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30566-3/fulltext?fbclid=IwAR3Hyjh3ax53XAGCxWpC3aNWx1k8_VEPxiOlfptMkVUinaN_MWHodgsIy1k https://www.thelancet.com/journals/lancet/article/PIIS0140-6...
- daxorid 7y ago
  Thanks. Specifically, from your citation: "In addition, angiotensin converting enzyme 2, the receptor for SARS-CoV-2, is expressed on myocytes and vascular endothelial cells, so there is at least theoretical potential possibility of direct cardiac involvement by the virus" The most sane hypothesis I've seen is that the virus will attack any cell with the ACE2 receptor, including the heart and kidneys: "Angiotensin converting enzyme 2 (ACE2) is an enzyme attached to the outer surface (cell membranes) of cells in the lungs, arteries, heart, kidney, and intestines." This would require the virus to enter the bloodstream from the lungs, which is possible after sufficient alveolar damage. ref: https://en.wikipedia.org/wiki/Angiotensin-converting_enzyme_2 https://en.wikipedia.org/wiki/Angiotensin-converting_enzyme_... As an aside, although Wikipedia doesn't mention it, testicular cells also express ACE2, leading to some worry about downstream fertility effects: https://www.medrxiv.org/content/10.1101/2020.02.12.20022418v1 https://www.medrxiv.org/content/10.1101/2020.02.12.20022418v...
  - nitrogen 7y ago
    Would that last point allow SARS-CoV-2 to become an endogenous virus?
  - krooj 7y ago
    Interesting point about the ACE2 receptors in the GI tract. I wonder if that's why certain infections present with GI symptoms?
_bxg1 7y ago
I wish these articles would be more specific about what they mean by "pre-existing heart conditions". I have slightly high blood pressure which has been known to enter hypertension territory before (by like 1 point), but I think mostly stays a bit below there. Never know how worried I should be.
BFatts 7y ago
It's interesting that the chloroquine has possibly been linked to cardiac arrest. Is is chloroquine, or possibly the virus that is causing? Or maybe both in combination?
jacquesm 7y ago
So, I've been battling this bug for the last three weeks or so, probably caught it on the way back from my last job in Finland. I expected an empty plane instead it was packed like it was the last train out of San Fernando and everybody was scared there never would be another one. After a week or so symptoms started in spite of having self-isolated already after the flight, so that's why I figure that is where I caught it, no positive confirmation because tests are still pretty rare around here but all the symptoms are present. At least I hope that I did not infect anybody else by taking that precaution. One thing I noticed (besides the hacking cough that does not seem to want to go away) was a pretty highly elevated heartrate at rest. Up to 20% higher than normal. I already had some lung damage to my right lung due to an earlier pneumonia, but also played saxophone which does a good job of teaching you how to breathe properly and may improve your lungcapacity a bit. The last couple of weeks have been a continuous rodeo of improvement and falling back again, today is the first day that I have a bit more energy, other than that the time over the last weeks was mostly spent sleeping. Today is the first time I've seen my heart rate at rest below 60, and I take that as a very good sign that I'm on the tail end of this. Wouldn't wish this on my worst enemy. If you can avoid this bug you really should. I totally believe that if I had had a worse general condition that I may have ended up in the hospital, and given the extra strain on the heart I find the heart damage not so much mysterious as logical. After all, if your lung capacity decreases due to fluid in your lungs then your heart and chest muscles will have to work harder (possibly much harder) to get your blood O2 levels to saturation (if they still can...).
- MrBuddyCasino 7y ago
  There is a hypothesis [0] that the virus attacks red blood cells and impacts their capacity to transport O2, and that the lung damage is actually caused by that, and not directly by the virus. Elevated heart rate makes a lot of sense. [0] see thread and linked paper: https://twitter.com/yishan/status/1244717172871409666 https://twitter.com/yishan/status/1244717172871409666
  - jacquesm 7y ago
    Reference?
throwanem 7y ago
Random speculation aside, if you (like me) are currently at the tail end of COVID-19 and beginning your convalescence from it, it's wise to assume you have some degree of myocarditis and behave accordingly - that is, as best you can, avoid activities that may strain your heart and circulatory system for a couple weeks to a month following end of active COVID-19 symptoms. I'm not a doctor, and this isn't medical advice, but it isn't alarmism either. It's well known that pneumonias, however caused, tend to be rough on the heart. So it's just common sense to regard this pneumonia the same way. Look at it this way. If you aren't at risk, but assume that you are, the worst that happens is nothing. If you are at risk, and assume that you aren't, you may well not be so lucky. So, especially when you may not be able to rely on the usual degree of hospital support - better safe than sorry.
m0zg 7y ago
There's a growing body of evidence that C19 attacks hemoglobin in the blood, with the effects similar to malaria (where the parasite uses hemoglobin as a nutrient source): blood with depleted hemoglobin simply can't carry as much oxygen, so people start gasping for air, their lungs swell, and then pneumonia kills them. Crucially, gasping for air seems to happen well before the onset of pneumonia. This also explains why diabetics are more severely affected. If that's the case, ventilators aren't going to help if you use air in them, without supplemental oxygen: even if you pump air into the patient's lungs, their blood simply won't be able to carry sufficient oxygen. You need to supplement with oxygen. It also explains why (hydroxy)chloroquine helps: if it stops/reduces depletion of hemoglobin (which it does [*]), the patient may never progress to pneumonia, because their blood is able to carry sufficient oxygen. For those who already have pneumonia, supplemental oxygen would be vital if they also have C19. Standard ARDS treatment protocol will not work well. https://chemrxiv.org/articles/COVID-19_Disease_ORF8_and_Surface_Glycoprotein_Inhibit_Heme_Metabolism_by_Binding_to_Porphyrin/11938173 https://chemrxiv.org/articles/COVID-19_Disease_ORF8_and_Surf...
dharma1 7y ago
ACE2 (the entry point for the virus in the lungs) is expressed in the heart too, so it makes sense that the virus could attack the heart directly. It could also be a side effect of chloroquine. Frustrating how little we know at this point.
eaxitect 7y ago
This might be the reason: Covid-19 attacks the 1-beta chain of hemoglobin to inhibit human heme metabolism link: https://chemrxiv.org/articles/COVID-19_Disease_ORF8_and_Surface_Glycoprotein_Inhibit_Heme_Metabolism_by_Binding_to_Porphyrin/11938173 https://chemrxiv.org/articles/COVID-19_Disease_ORF8_and_Surf...

255 points by branko_d 7y ago

One factor to consider: Some folks will be absolutely terrified to learn they have this disease, which may have real effects. An example: https://en.m.wikipedia.org/wiki/Voodoo_death https://en.m.wikipedia.org/wiki/Voodoo_death “These data suggest that vagus contributes to severe emotional states and may be related to emotional states of immobilization, such as extreme terror. Unfortunately, this immobilization technique is potentially life-threatening for mammals (but not for reptiles). Mammals would undergo states of bradycardia or hypoxia as an over-activation of parasympathetic vagus system. The organs of the oxygen-hungry mammal are deprived of oxygen due to lack of blood flow, and the animal dies.”

graeme 7y ago
That implies a low heart rate causing death, correct? If so, this would be an easy hypothesis to test based on heart rate. But also, do the rats in voodoo death have heart damage? These covid patients do. If the rats don’t, then you’re quite off track.
- guscost 7y ago
  It's just one example of a heart-related effect, that's all. Considering that we're all here reading another hypothesis that this is the first-ever respiratory pathogen to infect the heart, it doesn't seem that much of a stretch. We totally should research whether fear can lead to physical heart damage, but I would bet that "stress in general" is the source of this damage, not only emotional stress. See: https://www.medicalnewstoday.com/articles/295664 https://www.medicalnewstoday.com/articles/295664 https://www.medicalnewstoday.com/articles/317478 https://www.medicalnewstoday.com/articles/317478
Zenst 7y ago
Not heard it called this, was aware of https://en.wikipedia.org/wiki/Broken_heart#Broken_heart_syndrome https://en.wikipedia.org/wiki/Broken_heart#Broken_heart_synd... I do recall reading few articles that support it as an actual condition and makes logical sense that for some that will be a factor - lost loved one in same family, increases the odds of catching the virus and also a broken heart. Truly a tradgerday on many levels. Also mindful that the impact of this pandemic will see many indirect deaths in the years to come and the scale of things won't be measured in people who died and tested positive, but how the rest live.

carlsborg 7y ago

There is a paper circulating that claims that the virus impedes red blood cells leading to organ failure including lungs, and not the other way round.

bryanrasmussen 7y ago
so if it impedes red blood cells does this mean my gout is helping me out?
- tejtm 7y ago
  Could you explain the gout - bloodcell - lung damage connection to a non clinician? (me)
  - bryanrasmussen 7y ago
    well actually it's only some sorts of gout, caused by Polycythemia Vera https://rarediseases.org/rare-diseases/polycythemia-vera/ https://rarediseases.org/rare-diseases/polycythemia-vera/ "Gout and kidney stone associated with polycythemia vera occur due to the high turnover of red blood cells, which results in higher-than-normal uric acid production." So it overproduces red blood cells, and the parent comment said there was a theory covid-19 was causing a decrease in red blood cell production so I conjured the amusing scenario in my head of the two diseases fighting each other. An amusing, non-serious, scenario.
    - tejtm 7y ago
      I ask because I was recently doing background checks on a substance to mitigate nitric oxide induced lung damage (produced by damaged cells) which would work by by converting it to urea ... so maybe more than just amusing. and for you https://monarchinitiative.org/disease/MONDO:0005571 https://monarchinitiative.org/disease/MONDO:0005571
nanl2053 7y ago
Do you have a link?

bryanrasmussen 7y ago

is this 1 in 5 in people who are otherwise asymptomatic as well? I guess not, or we would be seeing a lot more dead but I wonder if there are any heart attacks occurring in otherwise asymptomatic people and not being marked down as Covid-19 related.

ludamad 7y ago
I just had a family friend die of a heart attack with no covid symptoms - definitely a scary time
- deleted 7y ago
  [deleted]
- juliushuijnk 7y ago
  A (distant) friend shared he lost his wife to hearth attack a couple of weeks ago out of the blue. I figure(d) it was random.
- rootusrootus 7y ago
  My otherwise fit brother dropped dead of a heart attack without a single warning symptom of any kind. But that was a year ago, so not COVID.
fock 7y ago
we are seeing a lot more dead in heavily affected regions. and there is no statistics about why they died... Personally I think this is quite worrying with a lot of people now thinking we put masks on and then can go back to work. If this is indeed having serious side effects, we need to eradicate this. Meaning total lockdown except absolute necessities (e.g. ask: will people die of physical reasons if this service is out for a week) worldwide, implemented yesterday.
- Bombthecat 7y ago
  Won't happen. We can't go in lockdown for 2 or three years..

PaulHoule 7y ago

There are ACE-2 receptors all over the heart.

panax 7y ago
https://www.youtube.com/watch?v=jAW6VBWTiAA#t=36m https://www.youtube.com/watch?v=jAW6VBWTiAA#t=36m ACE2 is also found in several other organs in which they are seeing multiple organ failure with this virus so it likely is can bind to them and contribute to damage in these organs including the heart but as OP says there are multiple ways the heart could be affected Loss of ACE2 receptors in the heart can cause impaired heart function https://www.youtube.com/watch?v=jAW6VBWTiAA#t=8m https://www.youtube.com/watch?v=jAW6VBWTiAA#t=8m
- PaulHoule 7y ago
  Also there is a close connection between the heart, kidney, kidneys and other organs. For instance, ACE1 and ACE2 receptors are involved in a complex hormonal system that manages your blood volume, blood pressure, etc. Antihypertensive drugs target this system at different points. (ACE inhibitor drugs such as Lisinopril target the ACE1 receptor and don't bind much to ACE2 at all) Liver failure can present with symptoms similar to asthma because if your kidneys can't get rid of water, the water will leak out of your lungs. I had a friend who passed away last year from a bacterial infection that got to his heart. We all have bacteria that live on our skin without problems, but if you get a wound they can get into your blood and go to your heart. He had heart valve damage which is bad because if your heart valves work improperly, it can damage your blood the way you can 'damage' cream by whipping it. This can cause clots to go into your lungs or your brain with bad results either way. He had open heart surgery but they had a hard time restarting his heart and he was in a coma for a few months before they removed his feeding tube. One reason why penicillin was a miracle was that all sorts of people who got even minor wounds (e.g. soldiers, children, farmers, ...) would progress like that before WWII.

sharph 7y ago

Was reverse causation considered? Those with some heart damage are more likely to be tested and hospitalized for COVID-19?

jpxw 7y ago
Article addresses this

rightbyte 7y ago

I wonder if the patients get too much hydroxychloroquine. It can couse heart failures.

jpxw 7y ago

Disclaimer: I’m not a medical professional. My understanding is that myocarditis is a possible, albeit rare, complication of many viral illnesses? Additionally, respiratory failure causes a massive strain on the heart, so it’s not hugely surprising that many patients would have heart complications. It would be interesting to know how many patients without respiratory distress develop these cardiac symptoms.

DanBC 7y ago
This doctor in Wales says that myocarditis is a leading cause of death for his covid patients in ITU, and that this often happens after they've started to recover from the respiratory stuff. https://youtu.be/ejlbCmRJMW4?t=472 https://youtu.be/ejlbCmRJMW4?t=472

dcolkitt 7y ago

This headline is definitely a lot scarier than the actual body of the study. The most likely cause of the heart damage by far is the systemic inflammation induced by pneumonia. We know this because pneumonia patients of all types often have heart strain afterwards[1]. But that damage is very rarely permanent as the risk subsides back to baseline given enough time. Until we see evidence of heart issues in patients without pneumonia complications, we shouldn't be any more scared of covid-19 as we were before. In particular young and healthy people still have very little risk from infection. Patients who recover without serious complications should not be afraid of hidden heart damage. [1] https://www.health.harvard.edu/heart-health/heart-attack-risk-rises-after-a-bout-of-pneumonia https://www.health.harvard.edu/heart-health/heart-attack-ris...

ck2 7y ago
myocarditis can happen from any virus infection it doesn't have to involve pneumonia lots of young athletes die from it after coming back too hard/fast from flu
deleted 7y ago
[deleted]
JumpCrisscross 7y ago
> The most likely cause of the heart damage by far is the systemic inflammation induced by pneumonia Isn’t this premature given the lack of data? We’re seeing an anomaly documented and being studied. It’s not cause for alarm. But neither does it merit such dismissal.
- SpicyLemonZest 7y ago
  I don't think it's premature, no. We have a lot of data indicating that it's a respiratory disease. It should be studied, almost any coronavirus anomaly is worth studying, but we know what conclusion to expect.
  - dboreham 7y ago
    Based on all the YouTube videos by doctors I've watched, heart failure is a known, expected and quite common consequence of severe respiratory disease.

411111111111111 7y ago

let me preface this by mentioning that i havent been tested for covid-19. two weeks ago i've been having real issues breathing. it felt like my upper body was borderline paralyzed and i had to really force myself to fully breathe in. this wasn't constant but happened every day for several hours each. especially at night. i got worried that i might have the virus so i checked my temperature and oxygen blood saturation as well as my pulse. temperature was fine (36.6°C-37.2°C), blood saturation was in the normal range, however it dropped from 97-100 when i wasnt having any issues to 94-97. my pulse rate however went from usually ~75-80 to >110 whenever i had breathing problems. it went away last week.. or so i though. i had another episode of that this morning, it was only for 3 hours today, however. it seems to be going away, but if it actually was (or is) the virus... it seems plausible to me. but i'm a person without any medical knowledge so ... listen to the people actually treating the patients, not random armchair specialists like they're frequent on hacker news -- especially in threads about covid-19.

covidchat25 7y ago
I've had the exact same symptoms as you: * Chest pain and breathing difficulties that gets worse at night. * Actually ended up on hospital twice because of it. * Pulse and blood pressure went high too.
- TheOtherHobbes 7y ago
  Similar symptoms a few weeks ago. I've had an off-on mild fever since. There's been something going around since Jan at least, although it's impossible to know if it's Covid-related or something else.
Cthulhu_ 7y ago
You could be having panic attacks; based on the fact you've got numbers, it sounds to me like you're actively monitoring your own blood saturation, which already implies you may be worrying too much about things like that. Don't underestimate the effects of worry and stress. If it's temporary and you don't have other symptoms then you probably don't have the virus.

cowpig 7y ago

There's so much blind speculation in this comment section. The kind that's intriguing and fun when it's about engineering/math/whatever, but dangerous when it's about the health effects of an ongoing pandemic. I hope moderators do something about it.

jpxw 7y ago
Can you explain how exactly it is “dangerous”?
- freehunter 7y ago
  Speculation on treatments for Covid-19 has already killed people: https://ktla.com/news/arizona-man-dies-after-taking-form-of-chloroquine-used-for-aquariums-in-apparent-attempt-to-treat-coronavirus/amp/ https://ktla.com/news/arizona-man-dies-after-taking-form-of-...
  - Cthulhu_ 7y ago
    Speculation is fine; this guy died from self-medicating. There is a difference. We shouldn't resort to censoring to protect stupid people.
    - deleted 7y ago
      [deleted]
  - trentnix 7y ago
    Guess what? ALL discussion about treatments for Covid-19 is speculation. That a Darwin award winner and his insane, political activist wife, neither of whom had Covid-19, ingested toxic chemicals (probably after indulging in mind altering chemicals) is not very good evidence that discussion on Hacker News should be curtailed in any way.
  - PaulHoule 7y ago
    Don't mess with pet meds no matter how tempting it may be. We have horses so we have phenylbutazone which is tempting to use instead of aspirin, ivermectin which you might be tempted to use instead of otc parental for roundworms, also a huge jar of thyroid hormone that might help you lose weight. I stay away.

nestlequ1k 7y ago

It's not "mysterious". Myocarditis is a common result of viral infections of any kind, and can persist for weeks after recovering from the virus itself.

throwawaylalala 7y ago

Scroll down to figure 1. Non survivors end up with cardiac and kidney injury. Interesting that this might shine light on the cause. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30566-3/fulltext?fbclid=IwAR3Hyjh3ax53XAGCxWpC3aNWx1k8_VEPxiOlfptMkVUinaN_MWHodgsIy1k https://www.thelancet.com/journals/lancet/article/PIIS0140-6...

daxorid 7y ago
Thanks. Specifically, from your citation: "In addition, angiotensin converting enzyme 2, the receptor for SARS-CoV-2, is expressed on myocytes and vascular endothelial cells, so there is at least theoretical potential possibility of direct cardiac involvement by the virus" The most sane hypothesis I've seen is that the virus will attack any cell with the ACE2 receptor, including the heart and kidneys: "Angiotensin converting enzyme 2 (ACE2) is an enzyme attached to the outer surface (cell membranes) of cells in the lungs, arteries, heart, kidney, and intestines." This would require the virus to enter the bloodstream from the lungs, which is possible after sufficient alveolar damage. ref: https://en.wikipedia.org/wiki/Angiotensin-converting_enzyme_2 https://en.wikipedia.org/wiki/Angiotensin-converting_enzyme_... As an aside, although Wikipedia doesn't mention it, testicular cells also express ACE2, leading to some worry about downstream fertility effects: https://www.medrxiv.org/content/10.1101/2020.02.12.20022418v1 https://www.medrxiv.org/content/10.1101/2020.02.12.20022418v...
- nitrogen 7y ago
  Would that last point allow SARS-CoV-2 to become an endogenous virus?
- krooj 7y ago
  Interesting point about the ACE2 receptors in the GI tract. I wonder if that's why certain infections present with GI symptoms?

_bxg1 7y ago

I wish these articles would be more specific about what they mean by "pre-existing heart conditions". I have slightly high blood pressure which has been known to enter hypertension territory before (by like 1 point), but I think mostly stays a bit below there. Never know how worried I should be.

BFatts 7y ago

It's interesting that the chloroquine has possibly been linked to cardiac arrest. Is is chloroquine, or possibly the virus that is causing? Or maybe both in combination?

jacquesm 7y ago

So, I've been battling this bug for the last three weeks or so, probably caught it on the way back from my last job in Finland. I expected an empty plane instead it was packed like it was the last train out of San Fernando and everybody was scared there never would be another one. After a week or so symptoms started in spite of having self-isolated already after the flight, so that's why I figure that is where I caught it, no positive confirmation because tests are still pretty rare around here but all the symptoms are present. At least I hope that I did not infect anybody else by taking that precaution. One thing I noticed (besides the hacking cough that does not seem to want to go away) was a pretty highly elevated heartrate at rest. Up to 20% higher than normal. I already had some lung damage to my right lung due to an earlier pneumonia, but also played saxophone which does a good job of teaching you how to breathe properly and may improve your lungcapacity a bit. The last couple of weeks have been a continuous rodeo of improvement and falling back again, today is the first day that I have a bit more energy, other than that the time over the last weeks was mostly spent sleeping. Today is the first time I've seen my heart rate at rest below 60, and I take that as a very good sign that I'm on the tail end of this. Wouldn't wish this on my worst enemy. If you can avoid this bug you really should. I totally believe that if I had had a worse general condition that I may have ended up in the hospital, and given the extra strain on the heart I find the heart damage not so much mysterious as logical. After all, if your lung capacity decreases due to fluid in your lungs then your heart and chest muscles will have to work harder (possibly much harder) to get your blood O2 levels to saturation (if they still can...).

MrBuddyCasino 7y ago
There is a hypothesis [0] that the virus attacks red blood cells and impacts their capacity to transport O2, and that the lung damage is actually caused by that, and not directly by the virus. Elevated heart rate makes a lot of sense. [0] see thread and linked paper: https://twitter.com/yishan/status/1244717172871409666 https://twitter.com/yishan/status/1244717172871409666
- jacquesm 7y ago
  Reference?

throwanem 7y ago

Random speculation aside, if you (like me) are currently at the tail end of COVID-19 and beginning your convalescence from it, it's wise to assume you have some degree of myocarditis and behave accordingly - that is, as best you can, avoid activities that may strain your heart and circulatory system for a couple weeks to a month following end of active COVID-19 symptoms. I'm not a doctor, and this isn't medical advice, but it isn't alarmism either. It's well known that pneumonias, however caused, tend to be rough on the heart. So it's just common sense to regard this pneumonia the same way. Look at it this way. If you aren't at risk, but assume that you are, the worst that happens is nothing. If you are at risk, and assume that you aren't, you may well not be so lucky. So, especially when you may not be able to rely on the usual degree of hospital support - better safe than sorry.

m0zg 7y ago

There's a growing body of evidence that C19 attacks hemoglobin in the blood, with the effects similar to malaria (where the parasite uses hemoglobin as a nutrient source): blood with depleted hemoglobin simply can't carry as much oxygen, so people start gasping for air, their lungs swell, and then pneumonia kills them. Crucially, gasping for air seems to happen well before the onset of pneumonia. This also explains why diabetics are more severely affected. If that's the case, ventilators aren't going to help if you use air in them, without supplemental oxygen: even if you pump air into the patient's lungs, their blood simply won't be able to carry sufficient oxygen. You need to supplement with oxygen. It also explains why (hydroxy)chloroquine helps: if it stops/reduces depletion of hemoglobin (which it does [*]), the patient may never progress to pneumonia, because their blood is able to carry sufficient oxygen. For those who already have pneumonia, supplemental oxygen would be vital if they also have C19. Standard ARDS treatment protocol will not work well. https://chemrxiv.org/articles/COVID-19_Disease_ORF8_and_Surface_Glycoprotein_Inhibit_Heme_Metabolism_by_Binding_to_Porphyrin/11938173 https://chemrxiv.org/articles/COVID-19_Disease_ORF8_and_Surf...

dharma1 7y ago

ACE2 (the entry point for the virus in the lungs) is expressed in the heart too, so it makes sense that the virus could attack the heart directly. It could also be a side effect of chloroquine. Frustrating how little we know at this point.

eaxitect 7y ago

This might be the reason: Covid-19 attacks the 1-beta chain of hemoglobin to inhibit human heme metabolism link: https://chemrxiv.org/articles/COVID-19_Disease_ORF8_and_Surface_Glycoprotein_Inhibit_Heme_Metabolism_by_Binding_to_Porphyrin/11938173 https://chemrxiv.org/articles/COVID-19_Disease_ORF8_and_Surf...